| NPI | 1447803259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN PRUSKY Orthodontist 424-254-9245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-07-21 |
| Last Update Date | 2019-07-21 |